NPS rotating term 2

Question 1

what are the 3 common nutritional haematinic deficiencies?

Answer 1

iron, folate and vitamin B12

Question 2

what are some causes of nutritional haematinic deficiencies?

Answer 2

Pregnancy, growth spurts, menorrhagia, poor dietary intake, haemolysis, active bleeding, coeliac disease, crohn’s disease, adverse drug effects

Question 3

in iron replacement therapies- which is preferred, oral iron or parenteral iron?

Answer 3

oral iron. Parenteral iron is reserved for more severe cases

Question 4

what improves the absorption of iron?

Answer 4

Vitamin C

Question 5

What are some SE of iron preparations?

Answer 5

GIT disturbances such as abdominal pain, constipation, diarrhoea, black discolouration of faeces

Question 6

what should we combine with iron when treating for iron deficiency anaemia?

Answer 6

Folate

Question 7

why must B12 be given BEFORE folate if B12 is required?

Answer 7

If folate is given first, can precipitate subacute degeneration of the spinal cord

Question 8

what is Ferro F?

Answer 8

Ferrous fumarate and folic acid

Question 9

after treating iron deficiency anaemia appropriately, how best might we measure the patient’s iron levels?

Answer 9

Ferritin levels

Question 10

In patients with proteinuria >1 g/day (with or without diabetes), the recommended BP target is ?

Answer 10

125/75

Question 11

Mr Reynolds is a 60-year-old man with heart failure and hypertension. Which antihypertensive agents are NOT recommended in patients with heart failure?

Answer 11

In heart failure or significantly impaired left ventricular function there is a risk of further depression of cardiac function with calcium channel blockers. The risk is greatest risk with verapamil, then diltiazem. There is less risk with dihydropyridines channel blockers but they should be used with caution.

Question 12

50-75% of patients with hypertension will not achieve BP targets on monotherapy. Which of the following are recommended combinations of antihypertensive agents?

Answer 12

Ace inhibitor + calcium channel blocker

Question 13

Three months after commencing methadone treatment Sasha tells her methadone prescriber that that she has started doctor shopping for Panadeine Forte (paracetamol 500 mg and codeine phosphate 30 mg) again. The most appropriate next step is:

Answer 13

Relapse to opioid misuse warrants review of current treatment and often suggests inadequate therapy and may be resolved by dose increase of opioid substitution therapy.

Question 14

Buprenorphine may cause precipitated withdrawal if dosed soon after a full opioid agonist in a dependent patient because

Answer 14

B/c of high affinity at the mu receptor. Buprenorphine may displace the full agonist from the receptor, and with only partial efficacy, the net effect is withdrawal.

Question 15

Methadone and buprenorphine are used in maintenance treatment of opioid dependence because both medications:

Answer 15

Long half-life allows for once daily supervised administration

Question 16

what is the goal of opioid substitution therapy?

Answer 16

to minimise potentially harmful illicit, prescription or OTC medication misuse.

Question 17

how is dose of methadone usually managed?

Answer 17

Methadone is usually initiated at a dose of 20-30 mg daily and titrated upward until withdrawal symptoms and cravings are suppressed.

Question 18

how is methadone and buprenorphine metabolised?

Answer 18

hepatic metabolism. hence alter dosage with hepatic impairment

Question 19

can we write a discharge prescription for methadone?

Answer 19

no. Can only be prescribed by an authorised prescriber of methadone

Question 20

SE of OTC therapy?

Answer 20

sedation, constipation, nausea and sweating.
Patients should abstain from alcohol while their dose is being titrated as the risk of toxicity is greater with the combination. Patients should also be cautioned about using NSAIDS and other OTC products

Question 21

what must we think about the long term side effects/consequences of hypnotic medication such as temazepam?

Answer 21

Long-term use of hypnotic medicines leads to tolerance, dependence and potential harm from adverse effects and drug interactions.
Tolerance to the hypnotic effects of benzodiazepines develops rapidly, sometimes after only a few days of regular use.
The risk of dependence increases with dose and duration of treatment. It is more pronounced in patients receiving long-term therapy and/or high dosage

Question 22

what is the preferred dosing method for hypnotic therapy?

Answer 22

If a hypnotic medicine is required, limit use to the shortest time possible (

Question 23

what are some non pharmacological methods to address insomnia?

Answer 23

1. Sleep hygiene
2. Relaxation therapy
3. sleep restriction therapy
4. cognitive behavioural therapy

Question 24

first line approach to insomnia?

Answer 24

non pharmacological methods

Question 25

common withdrawal symptoms for benzodiazepines?

Answer 25

Common withdrawal symptoms include sweating, feeling ill, dizziness, blurred vision, irritability, lack of concentration, feeling anxious, depression and sleeplessness. Intermittent use may be indicated for severe long standing disorders not relieved by non-drug measures.
Minimise potential harms of hypnotic medicines by engaging the patient in managing sleep difficulties.
The risk of falls is also a concern, particularly for older patients.

Question 26

when is rivaroxaban indicated for VTE prophylaxis prior to surgery?

Answer 26

Rivaroxaban is an oral anticoagulant approved for VTE prophylaxis after elective total hip or total knee replacement.
It is not approved for abdominal surgery.

Question 27

how we monitor a patient who is on clexane for VTE prophylaxis?

Answer 27

platelets
Hb
wound site
clinical manifestations of bleeding
renal function

Question 28

triple therapy for H pylori?

Answer 28

PPI and 2 x antibiotics

PPI + amoxycillin and clarithromycin

Question 29

what do we call drugs delivered by the rectum?

Answer 29

suppository